Cheat Sheetsâ¢. N/A. $42.00. 10. Cushion Repair Kits. N/A. $9.00. 10. Toll Free Phone: (800) 827-4548 | Toll Free Fax:
®
A Better Way to Sit™
2014 Price List
Table of Contents Seating Systems
HCPCS
MSRP
Page #
Meridian™
(less than 22" width) (22" or greater width)
E2624 E2625
$375.00 $458.00
1 1
Meridian Wave™ CPW
(less than 22" width) (22" or greater width)
E2624 E2625
$458.00 $530.00
1 1
Meridian Wave™ LPB
(less than 22" width) (22" or greater width)
E2624 E2625
$458.00 $530.00
2 2
Meridian Wave™ CPB
(less than 22" width) (22" or greater width)
E2624 E2625
$458.00 $530.00
2 2
Evolution PSV™
(less than 22" width) (22" or greater width)
E2622 E2623
$364.00 $442.00
3 3
Evolution PSV Wave™ CPW
(less than 22" width) (22" or greater width)
E2624 E2625
$432.00 $505.00
3 3
Evolution PSV Wave™ LPB
(less than 22" width) (22" or greater width)
E2624 E2625
$432.00 $505.00
4 4
Evolution PSV Wave™ CPB
(less than 22" width) (22" or greater width)
E2624 E2625
$432.00 $505.00
4 4
Evolution™
(less than 22" width) (22" or greater width)
E2622 E2623
$364.00 $442.00
5 5
Evolution Wave™ CPW
(less than 22" width) (22" or greater width)
E2624 E2625
$432.00 $505.00
5 5
Evolution Wave™ LPB
(less than 22" width) (22" or greater width)
E2624 E2625
$432.00 $505.00
6 6
Evolution Wave™ CPB
(less than 22" width) (22" or greater width)
E2624 E2625
$432.00 $505.00
6 6
ProForm NX™
(less than 22" width)
E2624
$442.00
7
Zoid PSV™
(less than 22" width)
E2622
$364.00
8
Reflex™
(less than 22" width)
E2603
$182.00
8
(less than 22" width)
E2622
$364.00
8
(less than 22" width) (22" or greater width)
N/A N/A
$104.00 $130.00
9 9
E0992 N/A N/A N/A N/A
$36.50 $52.00 $390.00 $42.00 $9.00
10 10 10 10 10
JUNIOR Seat Cushion
New!
Replacement Wave Bases Seating System Accessories Rigidizers Wedges Drop Base System Cheat Sheets™ Cushion Repair Kits
1
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U.S. Suggested Retail Price List Effective January 01, 2014
Table of Contents Back Systems
HCPCS
MSRP
Page #
Icon™ Back System Low
(less than 22" width)
E2613
$500.00
11
Icon™ Back System Mid
(less than 22" width) (22" or greater width)
E2615 E2616
$525.00 $650.00
11 11
Icon™ Back System Tall
(less than 22" width)
E2615
$550.00
11
Icon™ Back System Deep
(less than 22" width)
E2620
$650.00
11
JUNIOR Back Support Mid New! JUNIOR Back Support Deep JUNIOR Back Support Accessories
(less than 22" width) (less than 22" width)
E2613 E2620 N/A
$525.00 $575.00 Varies
12 12 12
Varies
Varies
12
Icon™ Back System Accessories Evolution Back™
(less than 22" width) (22" or greater width)
E2613 E2614
$445.00 $650.00
13 13
Evolution Back™ Tall
(less than 22" width)
E2613
$505.00
13
Evolution Back™ Deep
(less than 22" width)
E2620
$675.00
13
Varies
Varies
14
E2611
$350.00
15
Talon™ Accessories
N/A
Varies
15
Back System Accessories PSIS Block Lumbar Support Supplemental Lateral Support The Backrest™
N/A N/A N/A
$40.00 $40.00 $35.00
17 17 17
Evolution Back™ Accessories (less than 22" width)
Talon™
Lateral Supports PAL™ Swing-Away Supports Fixed Lateral Supports
Secondary Supports
HCPCS
MSRP
Page #
E0128 + E0956
$187.50
16
E0956
$75.00
17
HCPCS
MSRP
Page #
Hip Belts
E0978
Varies
18
Contoured Chest Harness
E0960
$130.00
19
E0960 or E0978
$40.00
19
E0978
$115.00
19
Tri-End Hardware
N/A
$20.00
19
Cam Lock Buckles
N/A
$4.00
19
Frame Clamps
N/A
$4.00
19
Chest Belt Band-It™ Ankle Support
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2
Seating Systems Meridian™ HCPCS: E2624 Skin Protection and Positioning Dimensions Mesh Incontinence 12x14 72000212141 72000212142 14x14 72000214141 72000214142 14x16 72000214161 72000214162 14x18 72000214181 72000214182 14x20 72000214201 72000214202 15x15 72000215151 72000215152 15x17 72000215171 72000215172 16x14 72000216141 72000216142 16x16 72000216161 72000216162 16x18 72000216181 72000216182 16x20 72000216201 72000216202 17x17 72000217171 72000217172 18x16 72000218161 72000218162 18x18 72000218181 72000218182 18x20 72000218201 72000218202 20x16 72000220161 72000220162 20x18 72000220181 72000220182 20x20 72000220201 72000220202
MSRP $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 02517 14x14 02518 14x16 02519 14x18 02619 14x20 02620 15x15 02621 15x17 02622 16x14 02623 16x16 02520 16x18 02521 16x20 02522 17x17 02523 18x16 02524 18x18 02525 18x20 02526 20x16 02527 20x18 02528 20x20 02529
Incontinence 02534 02535 02536 02624 02625 02626 02627 02628 02537 02538 02539 02540 02541 02542 02543 02544 02545 02546
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: E2625 Skin Protection and Positioning 22x18 72300222181 72300222182 $458.00 22x20 72300222201 72300222202 $458.00 24x18 72300224181 72300224182 $458.00 24x20 72300224201 72300224202 $458.00
Replacement Cover HCPCS: E2619 22x18 02530 22x20 02531 24x18 02532 24x20 02533
02547 02548 02549 02550
$104.00 $104.00 $104.00 $104.00
Meridian Wave™ CPW (Contoured Positioning Wedge) Cushion HCPCS: Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
E2624 Skin Protection and Positioning Mesh Incontinence MSRP 72001212141 72001212142 $458.00 72001214141 72001214142 $458.00 72001214161 72001214162 $458.00 72001214181 72001214182 $458.00 72001214201 72001214202 $458.00 72001215151 72001215152 $458.00 72001215171 72001215172 $458.00 72001216141 72001216142 $458.00 72001216161 72001216162 $458.00 72001216181 72001216182 $458.00 72001216201 72001216202 $458.00 72001217171 72001217172 $458.00 72001218161 72001218162 $458.00 72001218181 72001218182 $458.00 72001218201 72001218202 $458.00 72001220161 72001220162 $458.00 72001220181 72001220182 $458.00 72001220201 72001220202 $458.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 02551 14x14 02552 14x16 02553 14x18 02629 14x20 02630 15x15 02631 15x17 02632 16x14 02633 16x16 02554 16x18 02555 16x20 02556 17x17 02557 18x16 02558 18x18 02559 18x20 02560 20x16 02561 20x18 02562 20x20 02563
Incontinence 02568 02569 02570 02634 02635 02636 02637 02638 02571 02572 02573 02574 02575 02576 02577 02578 02579 02580
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: 22x18 22x20 24x18 24x20
E2625 Skin Protection and Positioning 72301222181 72301222182 $530.00 72301222201 72301222202 $530.00 72301224181 72301224182 $530.00 72301224201 72301224202 $530.00
Replacement Cover HCPCS: E2619 22x18 02564 22x20 02565 24x18 02566 24x20 02567
02581 02582 02583 02584
$104.00 $104.00 $104.00 $104.00
1
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U.S. Suggested Retail Price List Effective January 01, 2014
Seating Systems Meridian Wave™ LPB (Lateral Positioning Base) Cushion HCPCS: Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
E2624 Skin Protection and Positioning Mesh Incontinence MSRP 72002212141 72002212142 $458.00 72002214141 72002214142 $458.00 72002214161 72002214162 $458.00 72002214181 72002214182 $458.00 72002214201 72002214202 $458.00 72002215151 72002215152 $458.00 72002215171 72002215172 $458.00 72002216141 72002216142 $458.00 72002216161 72002216162 $458.00 72002216181 72002216182 $458.00 72002216201 72002216202 $458.00 72002217171 72002217172 $458.00 72002218161 72002218162 $458.00 72002218181 72002218182 $458.00 72002218201 72002218202 $458.00 72002220161 72002220162 $458.00 72002220181 72002220182 $458.00 72002220201 72002220202 $458.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 02585 14x14 02586 14x16 02587 14x18 02639 14x20 02640 15x15 02641 15x17 02642 16x14 02643 16x16 02588 16x18 02589 16x20 02590 17x17 02591 18x16 02592 18x18 02593 18x20 02594 20x16 02595 20x18 02596 20x20 02597
Incontinence 02602 02603 02604 02644 02645 02646 02647 02648 02605 02606 02607 02608 02609 02610 02611 02612 02613 02614
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: E2625 Skin Protection and Positioning 22x18 72302222181 72302222182 $530.00 22x20 72302222201 72302222202 $530.00 24x18 72302224181 72302224182 $530.00 24x20 72302224201 72302224202 $530.00
Replacement Cover HCPCS: E2619 22x18 02598 22x20 02599 24x18 02600 24x20 02601
02615 02616 02617 02618
$104.00 $104.00 $104.00 $104.00
Meridian Wave™ CPB (Contoured Positioning Base) Cushion HCPCS: Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
E2624 Skin Protection and Positioning Mesh Incontinence MSRP 72003212141 72003212142 $458.00 72003214141 72003214142 $458.00 72003214161 72003214162 $458.00 72003214181 72003214182 $458.00 72003214201 72003214202 $458.00 72003215151 72003215152 $458.00 72003215171 72003215172 $458.00 72003216141 72003216142 $458.00 72003216161 72003216162 $458.00 72003216181 72003216182 $458.00 72003216201 72003216202 $458.00 72003217171 72003217172 $458.00 72003218161 72003218162 $458.00 72003218181 72003218182 $458.00 72003218201 72003218202 $458.00 72003220161 72003220162 $458.00 72003220181 72003220182 $458.00 72003220201 72003220202 $458.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 02585 14x14 02586 14x16 02587 14x18 02639 14x20 02640 15x15 02641 15x17 02642 16x14 02643 16x16 02588 16x18 02589 16x20 02590 17x17 02591 18x16 02592 18x18 02593 18x20 02594 20x16 02595 20x18 02596 20x20 02597
Incontinence 02602 02603 02604 02644 02645 02646 02647 02648 02605 02606 02607 02608 02609 02610 02611 02612 02613 02614
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: E2625 Skin Protection and Positioning 22x18 72303222181 72303222182 $530.00 22x20 72303222201 72303222202 $530.00 24x18 72303224181 72303224182 $530.00 24x20 72303224201 72303224202 $530.00
Replacement Cover HCPCS: E2619 22x18 02598 22x20 02599 24x18 02600 24x20 02601
02615 02616 02617 02618
$104.00 $104.00 $104.00 $104.00
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2
Seating Systems Evolution PSV™ (Pressure Setting Valve) Cushion HCPCS: E2622 Skin Protection Dimensions Mesh Incontinence 12x14 72415 72425 14x14 74415 74425 14x16 74615 74625 14x18 74816 74826 14x20 74016 74026 15x15 75515 75525 15x17 75715 75725 16x14 76415 76425 16x16 76615 76625 16x18 76815 76825 16x20 76015 76025 17x17 77715 77725 18x16 78615 78625 18x18 78815 78825 18x20 78015 78025 20x16 70615 70625 20x18 70815 70825 20x20 70015 70025
MSRP $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 04623 14x14 04643 14x16 04645 14x18 04681 14x20 04682 15x15 04683 15x17 04684 16x14 04689 16x16 04665 16x18 04667 16x20 04601 17x17 04640 18x16 04685 18x18 04687 18x20 04679 20x16 04605 20x18 04607 20x20 04599
Incontinence 04624 04644 04646 04690 04691 04692 04695 04696 04666 04668 04602 04641 04686 04688 04680 04606 04608 04600
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: E2623 Skin Protection 22x18 72815 72825 22x20 72015 72025 24x18 74815 74825 24x20 74015 74025
$442.00 $442.00 $442.00 $442.00
Replacement Cover HCPCS: E2619 22X18 04620 22x20 04622 24x18 04626 24x20 04628
04621 04625 04627 04629
$104.00 $104.00 $104.00 $104.00
Evolution PSV Wave™ CPW (Contoured Positioning Wedge) Cushion HCPCS: Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
E2624 Skin Protection and Positioning Mesh Incontinence MSRP 71501112141 71501112142 $432.00 71501114141 71501114142 $432.00 71501114161 71501114162 $432.00 71501114181 71501114182 $432.00 71501114201 71501114202 $432.00 71501115151 71501115152 $432.00 71501115171 71501115172 $432.00 71501116141 71501116142 $432.00 71501116161 71501116162 $432.00 71501116181 71501116182 $432.00 71501116201 71501116202 $432.00 71501117171 71501117172 $432.00 71501118161 71501118162 $432.00 71501118181 71501118182 $432.00 71501118201 71501118202 $432.00 71501120161 71501120162 $432.00 71501120181 71501120182 $432.00 71501120201 71501120202 $432.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 05500 14x14 05501 14x16 05502 14x18 05745 14x20 05746 15x15 05747 15x17 05748 16x14 05749 16x16 05503 16x18 05504 16x20 05505 17x17 05506 18x16 05507 18x18 05508 18x20 05509 20x16 05510 20x18 05511 20x20 05512
Incontinence 05517 05518 05519 05750 05751 05752 05753 05754 05520 05521 05522 05523 05524 05525 05526 05527 05528 05529
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: 22x18 22x20 24x18 24x20
E2625 Skin Protection and Positioning 71801122181 71801122182 $505.00 71801122201 71801122202 $505.00 71801124181 71801124182 $505.00 71801124201 71801124202 $505.00
Replacement Cover HCPCS: E2619 22x18 05513 22x20 05514 24x18 05515 24x20 05516
05530 05531 05532 05533
$104.00 $104.00 $104.00 $104.00
3
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U.S. Suggested Retail Price List Effective January 01, 2014
Seating Systems Evolution PSV Wave™ LPB (Lateral Positioning Base) Cushion HCPCS: Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
E2624 Skin Protection and Positioning Mesh Incontinence MSRP 71502112141 71502112142 $432.00 71502114141 71502114142 $432.00 71502114161 71502114162 $432.00 71502114181 71502114182 $432.00 71502114201 71502114202 $432.00 71502115151 71502115152 $432.00 71502115171 71502115172 $432.00 71502116141 71502116142 $432.00 71502116161 71502116162 $432.00 71502116181 71502116182 $432.00 71502116201 71502116202 $432.00 71502117171 71502117172 $432.00 71502118161 71502118162 $432.00 71502118181 71502118182 $432.00 71502118201 71502118202 $432.00 71502120161 71502120162 $432.00 71502120181 71502120182 $432.00 71502120201 71502120202 $432.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 05700 14x14 05701 14x16 05702 14x18 05735 14x20 05736 15x15 05737 15x17 05738 16x14 05739 16x16 05703 16x18 05704 16x20 05705 17x17 05706 18x16 05707 18x18 05708 18x20 05709 20x16 05710 20x18 05711 20x20 05712
Incontinence 05717 05718 05719 05740 05741 05742 05743 05744 05720 05721 05722 05723 05724 05725 05726 05727 05728 05729
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: 22x18 22x20 24x18 24x20
E2625 Skin Protection and Positioning 71802122181 71802122182 $505.00 71802122201 71802122202 $505.00 71802124181 71802124182 $505.00 71802124201 71802124202 $505.00
Replacement Cover HCPCS: E2619 22x18 05713 22x20 05714 24x18 05715 24x20 05716
05730 05731 05732 05734
$104.00 $104.00 $104.00 $104.00
Evolution PSV Wave™ CPB (Contoured Positioning Base) Cushion HCPCS: Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
E2624 Skin Protection and Positioning Mesh Incontinence MSRP 71503112141 71503112142 $432.00 71503114141 71503114142 $432.00 71503114161 71503114162 $432.00 71503114181 71503114182 $432.00 71503114201 71503114202 $432.00 71503115151 71503115152 $432.00 71503115171 71503115172 $432.00 71503116141 71503116142 $432.00 71503116161 71503116162 $432.00 71503116181 71503116182 $432.00 71503116201 71503116202 $432.00 71503117171 71503117172 $432.00 71503118161 71503118162 $432.00 71503118181 71503118182 $432.00 71503118201 71503118202 $432.00 71503120161 71503120162 $432.00 71503120181 71503120182 $432.00 71503120201 71503120202 $432.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 05700 14x14 05701 14x16 05702 14x18 05735 14x20 05736 15x15 05737 15x17 05738 16x14 05739 16x16 05703 16x18 05704 16x20 05705 17x17 05706 18x16 05707 18x18 05708 18x20 05709 20x16 05710 20x18 05711 20x20 05712
Incontinence 05717 05718 05719 05740 05741 05742 05743 05744 05720 05721 05722 05723 05724 05725 05726 05727 05728 05729
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: 22x18 22x20 24x18 24x20
E2625 Skin Protection and Positioning 71803122181 71803122182 $505.00 71803122201 71803122202 $505.00 71803124181 71803124182 $505.00 71803124201 71803124202 $505.00
Replacement Cover HCPCS: E2619 22x18 05713 22x20 05714 24x18 05715 24x20 05716
05730 05731 05732 05734
$104.00 $104.00 $104.00 $104.00
Toll Free Phone: (800) 827-4548 | Toll Free Fax: (800) 363-7739 | www.varilite.com
4
Seating Systems Evolution™ Cushion HCPCS: E2622 Skin Protection Dimensions Mesh Incontinence 12x14 72410 72420 14x14 74410 74420 14x16 74610 74620 14x18 74810 74820 14x20 74010 74020 15x15 75510 75520 15x17 75710 75720 16x14 76410 76420 16x16 76610 76620 16x18 76810 76820 16x20 76010 76020 17x17 77710 77720 18x16 78610 78620 18x18 78810 78820 18x20 78010 78020 20x16 70610 70620 20x18 70810 70820 20x20 70010 70020
MSRP $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 04623 14x14 04643 14x16 04645 14x18 04681 14x20 04682 15x15 04683 15x17 04684 16x14 04689 16x16 04665 16x18 04667 16x20 04601 17x17 04640 18x16 04685 18x18 04687 18x20 04679 20x16 04605 20x18 04607 20x20 04599
Incontinence 04624 04644 04646 04690 04691 04692 04695 04696 04666 04668 04602 04641 04686 04688 04680 04606 04608 04600
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: E2623 Skin Protection 22x18 7281B 7282B 22x20 7201B 7202B 24x18 7481B 7482B 24x20 7401B 7402B
$442.00 $442.00 $442.00 $442.00
Replacement Cover HCPCS: E2619 22x18 04620 22x20 04622 24x18 04626 24x20 04628
04621 04625 04627 04629
$104.00 $104.00 $104.00 $104.00
Evolution Wave™ CPW (Contoured Positioning Wedge) Cushion HCPCS: Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
E2624 Skin Protection and Positioning Mesh Incontinence MSRP 71001112141 71001112142 $432.00 71001114141 71001114142 $432.00 71001114161 71001114162 $432.00 71001114181 71001114182 $432.00 71001114201 71001114202 $432.00 71001115151 71001115152 $432.00 71001115171 71001115172 $432.00 71001116141 71001116142 $432.00 71001116161 71001116162 $432.00 71001116181 71001116182 $432.00 71001116201 71001116202 $432.00 71001117171 71001117172 $432.00 71001118161 71001118162 $432.00 71001118181 71001118182 $432.00 71001118201 71001118202 $432.00 71001120161 71001120162 $432.00 71001120181 71001120182 $432.00 71001120201 71001120202 $432.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 05500 14x14 05501 14x16 05502 14x18 05745 14x20 05746 15x15 05747 15x17 05748 16x14 05749 16x16 05503 16x18 05504 16x20 05505 17x17 05506 18x16 05507 18x18 05508 18x20 05509 20x16 05510 20x18 05511 20x20 05512
Incontinence 05517 05518 05519 05750 05751 05752 05753 05754 05520 05521 05522 05523 05524 05524 05526 05527 05528 05529
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: 22x18 22x20 24x18 24x20
E2625 Skin Protection and Positioning 71301122181 71301122182 $505.00 71301122201 71301122202 $505.00 71301124181 71301124182 $505.00 71301124201 71301124202 $505.00
Replacement Cover HCPCS: E2619 22x18 05513 22x20 05514 24x18 05515 24x20 05516
05530 05531 05532 05533
$104.00 $104.00 $104.00 $104.00
5
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U.S. Suggested Retail Price List Effective January 01, 2014
Seating Systems Evolution Wave™ LPB (Lateral Positioning Base) Cushion HCPCS: Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
E2624 Skin Protection and Positioning Mesh Incontinence MSRP 71002112141 71002112142 $432.00 71002114141 71002114142 $432.00 71002114161 71002114162 $432.00 71002114181 71002114182 $432.00 71002114201 71002114202 $432.00 71002115151 71002115152 $432.00 71002115171 71002115172 $432.00 71002116141 71002116142 $432.00 71002116161 71002116162 $432.00 71002116181 71002116182 $432.00 71002116201 71002116202 $432.00 71002117171 71002117172 $432.00 71002118161 71002118162 $432.00 71002118181 71002118182 $432.00 71002118201 71002118202 $432.00 71002120161 71002120162 $432.00 71002120181 71002120182 $432.00 71002120201 71002120202 $432.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 05700 14x14 05701 14x16 05702 14x18 05735 14x20 05736 15x15 05737 15x17 05738 16x14 05739 16x16 05703 16x18 05704 16x20 05705 17x17 05706 18x16 05707 18x18 05708 18x20 05709 20x16 05710 20x18 05711 20x20 05712
Incontinence 05717 05718 05719 05740 05741 05742 05743 05744 05720 05721 05722 05723 05724 05725 05726 05727 05728 05729
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: 22x18 22x20 24x18 24x20
E2625 Skin Protection and Positioning 71302122181 71302122182 $505.00 71302122201 71302122202 $505.00 71302124181 71302124182 $505.00 71302124201 71302124202 $505.00
Replacement Cover HCPCS: E2619 22x18 05713 22x20 05714 24x18 05715 24x20 05716
05730 05731 05732 05734
$104.00 $104.00 $104.00 $104.00
Evolution Wave™ CPB (Contoured Positioning Base) Cushion HCPCS: Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
E2624 Skin Protection and Positioning Mesh Incontinence MSRP 71003112141 71003112142 $432.00 71003114141 71003114142 $432.00 71003114161 71003114162 $432.00 71003114181 71003114182 $432.00 71003114201 71003114202 $432.00 71003115151 71003115152 $432.00 71003115171 71003115172 $432.00 71003116141 71003116142 $432.00 71003116161 71003116162 $432.00 71003116181 71003116182 $432.00 71003116201 71003116202 $432.00 71003117171 71003117172 $432.00 71003118161 71003118162 $432.00 71003118181 71003118182 $432.00 71003118201 71003118202 $432.00 71003120161 71003120162 $432.00 71003120181 71003120182 $432.00 71003120201 71003120202 $432.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x14 05700 14x14 05701 14x16 05702 14x18 05735 14x20 05736 15x15 05737 15x17 05738 16x14 05739 16x16 05703 16x18 05704 16x20 05705 17x17 05706 18x16 05707 18x18 05708 18x20 05709 20x16 05710 20x18 05711 20x20 05712
Incontinence 05717 05718 05719 05740 05741 05742 05743 05744 05720 05721 05722 05723 05724 05725 05726 05727 05728 05729
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Bariatric HCPCS: 22x18 22x20 24x18 24x20
E2625 Skin Protection and Positioning 71303122181 71303122182 $505.00 71303122201 71303122202 $505.00 71303124181 71303124182 $505.00 71303124201 71303124202 $505.00
Replacement Cover HCPCS: E2619 22x18 05713 22x20 05714 24x18 05715 24x20 05716
05730 05731 05732 05734
22x18 22x20 24x18 24x20
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6
Seating Systems ProForm NX™ Single Chamber
ProForm NX™ Dual Chamber
Cushion HCPCS: E2624 Skin Protection and Positioning Dimensions Mesh Incontinence MSRP 12x14 72411 72421 $442.00 14x14 74411 74421 $442.00 14x16 74611 74621 $442.00 15x15 75511 75521 $442.00 15x17 75711 75721 $442.00 16x16 76611 76621 $442.00 16x18 76811 76821 $442.00 16x20 76011 76021 $442.00 17x17 77711 77721 $442.00 18x16 78611 78621 $442.00 18x18 78811 78821 $442.00 18x20 78011 78021 $442.00 20x16 70611 70621 $442.00 20x18 70811 70821 $442.00 20x20 70011 70021 $442.00
Cushion HCPCS: E2624 Skin Protection and Positioning Dimensions Mesh Incontinence 12x14 72412 72422 14x14 74412 74422 14x16 74612 74622 15x15 75512 75522 15x17 78712 75722 16x16 76612 76622 16x18 76812 76822 16x20 76012 76022 17x17 77712 77722 18x16 78612 78622 18x18 78812 78822 18x20 78012 78022 20x16 70612 70622 20x18 70812 70822 20x20 70012 70022
MSRP $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00
ProForm NX™ Replacement Parts Replacement Cover
Replacement Cushion
Replacement Cover HCPCS: E2619 Dimensions Mesh Incontinence 12x14 01760 01750 14x14 01761 01751 14x16 01762 01752 15x15 01740 01745 15x17 01741 01746 16x16 01763 01753 16x18 01764 01754 16x20 01765 01755 17x17 01742 01747 18x16 01766 01756 18x18 01767 01757 18x20 01768 01758 20x16 01743 01748 20x18 01744 01749 20x20 01769 01759
7
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Replacement Cushion HCPCS: None Dimensions Single-Chamber 12x7 01780 14x7 01781 14x8 01782 15x7.5 01790 15x8.5 01791 16x8 01784 16x9 01785 16x10 01783 17x8.5 01792 18x8 01787 18x9 01788 18x10 01786 20x8 01793 20x9 01794 20x10 01789
Dual-Chamber 01770 01771 01772 01795 01796 01774 01775 01773 01797 01777 01778 01776 01798 01799 01779
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MSRP $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00
U.S. Suggested Retail Price List Effective January 01, 2014
Seating Systems Zoid PSV™ Cushion HCPCS: E2622 Skin Protection Dimensions Mesh Incontinence 12x8 32800 32810 12x12 32200 32210 12x14 32400 32410 14x14 34400 34410 14x16 34600 34610 14x18 34800 34810 15x15 35500 35510 15x17 35700 35710 16x16 36600 36610 16x18 36800 36810 16x20 36000 36010 17x17 37700 37710 18x16 38300 38310 18x18 38800 38810 18x20 38000 38010 20x16 30600 30610 20x18 30800 30810 20x20 30000 30010
MSRP $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00 $364.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x8 04651 12x12 04652 12x14 04653 14x14 04654 14x16 04655 14x18 04697 15x15 04698 15x17 04699 16x16 04656 16x18 04659 16x20 04847 17x17 04888 18x16 04571 18x18 04657 18x20 04572 20x16 04573 20x18 04514 20x20 04532
Incontinence 04702 04711 04712 04715 04719 04720 04721 04722 04725 04726 04727 04728 04729 04730 04731 04741 04781 04785
MSRP $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00
Cushion HCPCS: E2603 Non-adjustable Skin Protection Dimensions Mesh Incontinence MSRP 12x12 N/A 73500112122 $182.00 12x14 N/A 73500112142 $182.00 14x14 N/A 73500114142 $182.00 14x16 N/A 73500114162 $182.00 14x18 N/A 73500114182 $182.00 14x20 N/A 73500114202 $182.00 15x15 N/A 73500115152 $182.00 15x17 N/A 73500115172 $182.00 16x14 N/A 73500116142 $182.00 16x16 N/A 73500116162 $182.00 16x18 N/A 73500116182 $182.00 16x20 N/A 73500116202 $182.00 17x17 N/A 73500117172 $182.00 18x16 N/A 73500118162 $182.00 18x18 N/A 73500118182 $182.00 18x20 N/A 73500118202 $182.00 20x16 N/A 73500120162 $182.00 20x18 N/A 73500120182 $182.00 20x20 N/A 73500120202 $182.00
Replacement Cover HCPCS: E2619 Dimensions Mesh 12x12 N/A 12x14 N/A 14x14 N/A 14x16 N/A 14x18 N/A 14x20 N/A 15x15 N/A 15x17 N/A 16x14 N/A 16x16 N/A 16x18 N/A 16x20 N/A 17x17 N/A 18x16 N/A 18x18 N/A 18x20 N/A 20x16 N/A 20x18 N/A 20x20 N/A
Incontinence 05534 05535 05536 05537 05538 05539 05540 05541 05542 05543 05544 05545 05546 05547 05548 05549 05578 05550 05551
MSRP $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50
Replacement Cover HCPCS: E2619 Dimensions Mesh 10x10 N/A
Incontinence 07222
MSRP $78.00
Reflex™
JUNIOR Seat Cushion Cushion HCPCS: E2622 Skin Protection Dimensions Mesh Incontinence 10x10 N/A 77000110102
New!
MSRP $364.00
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8
Replacement Wave Bases Wave CPW (Contoured Positioning Wedge) Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20 Bariatric 22x18 22x20 24x18 24x20
Wave LPB (Lateral Positioning Base)
Item Number 05410 05411 05412 05400 05401 05402 05403 05404 05413 05414 05415 05416 05417 05418 05419 05420 05421 05422
MSRP $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00
Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20
Item Number 05427 05428 05429 05405 05406 05407 05408 05409 05430 05431 05432 05433 05434 05435 05436 05437 05438 05439
MSRP $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00
05423 05424 05425 05426
$130.00 $130.00 $130.00 $130.00
22x18 22x20 24x18 24x20
05440 05441 05442 05443
$130.00 $130.00 $130.00 $130.00
Wave CPB (Contoured Positioning Base) Dimensions 12x14 14x14 14x16 14x18 14x20 15x15 15x17 16x14 16x16 16x18 16x20 17x17 18x16 18x18 18x20 20x16 20x18 20x20 Bariatric 22x18 22x20 24x18 24x20
9
Item Number 05444 05445 05446 05461 05462 05463 05464 05465 05447 05448 05449 05450 05451 05452 05453 05454 05455 05456
MSRP $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00
05457 05457 05459 05460
$130.00 $130.00 $130.00 $130.00
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U.S. Suggested Retail Price List Effective January 01, 2014
Seating System Accessories Rigidizers (Solid Inserts)
Wedges
HCPCS: E0992 Wheelchair Solid Seat Insert Dimensions Item Number MSRP 12X12 04360 $36.50 12X14 04390 $36.50 14X14 04260 $36.50 14X16/16X14 04380 $36.50 14X18 04535 $36.50 14X20 04536 $36.50 15X15 04537 $36.50 15X17 04538 $36.50 16X16 04280 $36.50 16X18/18X16 04300 $36.50 16X20/20X16 04290 $36.50 17X17 04389 $36.50 18X18 04370 $36.50 18X20/20X18 04240 $36.50 20X20 04250 $36.50
HCPCS: None Dimensions 12 14 15 16 17 18 20 22 24
Item Number 04352 04355 04574 04357 04377 04358 04359 04397 04399
Drop Base System
Drop Base Accessories
HCPCS: None Dimensions (in.) (WxD) 14x16 (fits 13-14 in.) 16x16 (fits 15-16 in.) 16x18 (fits 15-16 in.) 18x16 (fits 17-18 in.) 18x18 (fits 17-18 in.) 20x20 (fits 19-20 in.)
HCPCS: None Description Hardware Kit
Item Number 04388 04288 04308 04278 04378 04258
MSRP $390.00 $390.00 $390.00 $390.00 $390.00 $390.00
Dimensions One Size
Item Number 04351
Item Number 02102
MSRP $42.00
Finger Lock Hardware Kit
Cheat Sheets™
HCPCS: None Dimensions One Size
HCPCS: None Dimensions (4) 10x10 in.
Item Number 04330
MSRP $21.00
MSRP $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00
MSRP $156.00
Cushion Repair Kits HCPCS: None Description Repair Kit Standard Valve Kit PSV Valve Kit
Item Number 03663 03681 03682
MSRP $9.00 $9.00 $9.00
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10
Icon™ Back System with VariLock™ Hardware Icon Back System Low HCPCS: E2613 Positioning Wheelchair Back Cushion Size (in.) Item Number Height (in.) 14 4400321410 7.25 15 4400321510 7.7 16 4400321610 8.25 17 4400321710 8.7 18 4400321810 9.1 20 4400322010 9.5
MSRP $500.00 $500.00 $500.00 $500.00 $500.00 $500.00
Replacement Cover HCPCS: E2619 Size (in.) Item Number 14 07168 15 07169 16 07170 17 07171 18 07172 20 07173
MSRP $70.00 $70.00 $70.00 $70.00 $70.00 $70.00
Cushion HCPCS: E2615 Positioning Wheelchair Back Cushion Size (in.) Item Number Height (in.) MSRP 12 4400121210 9.7 $525.00 14 4400121410 11.2 $525.00 15 4400121510 12 $525.00 16 4400121610 12.7 $525.00 17 4400121710 13.5 $525.00 18 4400121810 14.25 $525.00 20 4400122010 15.75 $525.00
Replacement Cover HCPCS: E2619 Size (in.) Item Number 12 07174 14 07175 15 07176 16 07177 17 07178 18 07179 20 07180
MSRP $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00
Bariatric HCPCS: E2616 Positioning Wheelchair Back Cushion 22 4420122210 15.75 $650.00 24 4420122410 15.75 $650.00
Replacement Cover HCPCS: E2619 22 07181 24 07182
$110.00 $110.00
MSRP $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00
Replacement Cover HCPCS: E2619 Size (in.) Item Number 12 07183 14 07184 15 07185 16 07186 17 07187 18 07188 20 07189
MSRP $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00
MSRP $650.00 $650.00 $650.00 $650.00 $650.00 $650.00
Replacement Cover HCPCS: E2619 Size (in.) Item Number 14 07190 15 07191 16 07192 17 07193 18 07194 20 07195
MSRP $125.00 $125.00 $125.00 $125.00 $125.00 $125.00
Icon Back System Mid
Icon Back System Tall HCPCS: E2615 Positioning Wheelchair Back Cushion Size (in.) Item Number Height (in.) 12 4400221210 14.6 14 4400221410 17 15 4400221510 18.2 16 4400221610 19.4 17 4400221710 20.5 18 4400221810 21.75 20 4400222010 23.6
Icon Back System Deep HCPCS: E2620 Positioning Wheelchair Back Cushion Size (in.) Item Number Height (in.) 14 4400421410 17 15 4400421510 18.2 16 4400421610 19.4 17 4400421710 20.6 18 4400421810 21.75 20 4400422010 23.6
11
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U.S. Suggested Retail Price List Effective January 01, 2014
JUNIOR Back Support and Accessories JUNIOR Back Support Mid
New!
HCPCS: E2613 Positioning Wheelchair Back Cushion Size (in.) Item Number Height (in.) MSRP 10 4430111020 9.25 $525.00
JUNIOR Back Support Deep
Description JUNIOR Mounting Kit JUNIOR Nut and Bolt Kit
Item Number 07226 07227
MSRP $80.00
Replacement Cover HCPCS: E2619 Size (in.) Item Number 10 07221
MSRP $100.00
New!
HCPCS: E2620 Positioning Wheelchair Back Cushion Size (in.) Item Number Height (in.) MSRP 10 4430411020 9.25 $575.00
JUNIOR Back Support Accessories
Replacement Cover HCPCS: E2619 Size (in.) Item Number 10 07220
New!
MSRP $130.00 $23.00
Icon™ Back System Cushions and Accessories Icon Back System Low
Icon Back System Mid
Replacement Cushion Replacement Cushion HCPCS: None Size (in.) Item Number MSRP 14 07140 $125.00 15 07141 $125.00 16 07142 $125.00 17 07143 $125.00 18 07144 $125.00 20 07145 $125.00
Replacement Cushion Replacement Cushion HCPCS: None Size (in.) Item Number 12 07146 14 07147 15 07148 16 07149 17 07150 18 07151 20 07152
MSRP $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00
Bariatric 22 24
$260.00 $260.00
07153 07154
Icon Back System Tall
Icon Back System Deep
Replacement Cushion
Replacement Cushion
Replacement Cushion HCPCS: None Size (in.) Item Number MSRP 12 07155 $235.00 14 07156 $235.00 15 07157 $235.00 16 07158 $235.00 17 07159 $235.00 18 07160 $235.00 20 07161 $235.00
Replacement Cushion HCPCS: None Size (in.) Item Number 14 07162 15 07163 16 07164 17 07165 18 07166 20 07167
MSRP $260.00 $260.00 $260.00 $260.00 $260.00 $260.00
Icon Back System Accessories Description Item Number VariLock Upgrade Kit 07485 VariLock Hardware Kit, Complete 07484 VariLock Mounting Kit 07483 VariLock Slide Bracket Kit 07304 Nut and Bolt Kit 07196
MSRP $79.00 $196.00 $123.00 $29.00 $6.00
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12
Evolution Back™ System Evolution Back System Regular HCPCS: E2613 Positioning Wheelchair Back Cushion Size (in.) Item Number Height (in.) 12 47506 10.2 14 47500 12 15 47501 13 16 47502 14 17 47503 15 18 47504 16 20 47505 18
MSRP $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00
Replacement Cover HCPCS: E2619 Size (in.) Item Number 12 04618 14 04610 15 04611 16 04612 17 04613 18 04614 20 04615
MSRP $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00
Bariatric HCPCS: E2614 Positioning Wheelchair Back Cushion 22 47507 18 $650.00 24 47508 18 $650.00
Replacement Cover HCPCS: E2619 22 04619 24 04636
$100.00 $100.00
MSRP $505.00 $505.00 $505.00 $505.00 $505.00 $505.00 $505.00
Replacement Cover HCPCS: E2619 Size (in.) Item Number 12 04637 14 04630 15 04631 16 04632 17 04633 18 04634 20 04635
MSRP $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00
MSRP $675.00 $675.00 $675.00 $675.00 $675.00 $675.00
Replacement Cover HCPCS: E2619 Size (in.) Item Number 14 04639 15 04603 16 04604 17 04609 18 04616 20 04617
MSRP $120.00 $120.00 $125.00 $125.00 $125.00 $125.00
Evolution Back System Tall HCPCS: E2613 Positioning Wheelchair Back Cushion Size (in.) Item Number Height (in.) 12 47516 14 14 47510 16.3 15 47511 17.5 16 47512 19 17 47513 20.5 18 47514 22 20 47515 25
Evolution Back System Deep HCPCS: E2620 Positioning Wheelchair Back Cushion Size (in.) Item Number Height (in.) 14 47518 16.8 15 47520 18 16 47522 19.2 17 47524 20.8 18 47526 22.2 20 47528 25.2
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U.S. Suggested Retail Price List Effective January 01, 2014
Evolution Back™ System Cushions and Accessories Evolution Back System Regular
Evolution Back System Tall
Replacement Cushion
Replacement Cushion
Replacement Cushion HCPCS: None Size (in.) Item Number MSRP 12 01348 $200.00 14 01267 $200.00 15 01268 $200.00 16 01269 $200.00 17 01288 $200.00 18 01289 $200.00 20 01293 $200.00
Replacement Cushion HCPCS: None Size (in.) Item Number 12 01358 14 01312 15 01308 16 01309 17 01317 18 01318 20 01319
Bariatric 22 24
01349 01350
MSRP $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00
$250.00 $250.00
Evolution Back System Deep Replacement Cushion Replacement Cushion HCPCS: None Size (in.) Item Number MSRP 14 01364 $250.00 15 01337 $250.00 16 01338 $250.00 17 01339 $250.00 18 01343 $250.00 20 01347 $250.00
Evolution Back System Hardware Description Hardware Kit Upper Cane Clips Lower Cane Clips Standard Pin Bar Assembly Extended Pin Bar Assembly Complete Hardware Kit 7/8" Shim Kit 3/4" Shim Kit 5/8" Shim Kit 1/2" Shim Kit
Item Number 04650 04660 04670 04581 04582 04700 04595 04596 04597
MSRP $110.00 $80.00 $60.00 $25.00 $30.00 $175.00 $15.00 $15.00 $15.00
04598
$15.00
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Talon™ Back System & Accessories Talon Back System HCPCS: E2611 General Use Wheelchair Back Cushion Size (in.) Item Number Height (in.) MSRP 14 47517 6.1 $350.00 15 47519 6.6 $350.00 16 47521 7 $350.00 17 47523 7.5 $350.00 18 47525 7.8 $350.00 20 47527 8.8 $350.00
No-Charge Mounting Bracket (Required)* Size Item Number Short 47532 Medium 47533 Long 47534 * Replacement Mounting Bracket $35.00.
Talon Replacement Parts Replacement Cover
Replacement Cushion
Replacement Cover HCPCS: E2619 Size (in.) 14 15 16 17 18 20
Item Number 04638 04642 04647 04648 04649 04658
Replacement Cushion HCPCS: None MSRP $90.00 $90.00 $90.00 $90.00 $90.00 $90.00
Size (in.) 14 15 16 17 18 20
Item Number 01359 01368 01369 01371 01377 01378
MSRP $115.00 $115.00 $115.00 $115.00 $115.00 $115.00
Modesty Kit HCPCS: None Size (in.) 14-15 16-17 18-20
Item Number 04584 04585 04586
MSRP $30.00 $30.00 $30.00
Mounting Kit HCPCS: None Size Short Medium Long
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Item Number 47529 47530 47531
MSRP $150.00 $150.00 $150.00
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U.S. Suggested Retail Price List Effective January 01, 2014
PAL™ Swing-Away Lateral Supports Step 1 - Add Swing-Away Hinge (Sold as Each) HCPCS: E1028 Wheelchair Accessory, Manual Swing-Away Item Number Description MSRP 04374 Hinge Mechanism $112.50
Step 2 - Select Type of Bracket (Sold as Each) HCPCS: E0956 Wheelchair Accessory, Lateral Trunk or Hip Support Item Number Description MSRP (Horizontal pad adjustment 1") Short Fits Evolution/Icon Backs 12" 89050 $75.00 Fits Evolution/Icon Back 14-15" 89010 $75.00 Fits Evolution/Icon Back 16-17" 89020 $75.00 Fits Evolution/Icon Back 18" 89030 $75.00 Fits Evolution/Icon Back 20-24" 89040 $75.00 Long 89150 89110 89120 89130 89140
(Horizontal pad adjustment 2 ¼") Fits Evolution/Icon Backs 12" Fits Evolution/Icon Back 14-15" Fits Evolution/Icon Back 16-17" Fits Evolution/Icon Back 18" Fits Evolution/Icon Back 20-24"
$75.00 $75.00 $75.00 $75.00 $75.00
Offset 89250 89210 89220 89230
(Horizontal pad adjustment 1") Fits Evolution/Icon Backs 12" Fits Evolution/Icon Back 14-15" Fits Evolution/Icon Back 16-17" Fits Evolution/Icon Back 18"
$75.00 $75.00 $75.00 $75.00
89240
Fits Evolution/Icon Back 20-24"
$75.00
Step 3 - Select Type of Pad (Sold as Each) Included in price of bracket. Replacements are $37.50 each. HCPCS: Included in HCPCS Code for bracket Item Number Size (in.) Contoured 04317 3X4 04319 4X5 04321 5X6 Linear 04307 04309 04311
3X4 4X5 5X6
Lateral Support System Accessories Item Number Description 04577 PAL Hinge Cover
MSRP $6.00
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Fixed Lateral Supports Step 1 - Select Type of Bracket (Sold as Each) HCPCS: E0956 Wheelchair Accessory, Lateral Trunk or Hip Support Item Number Description MSRP (Horizontal pad adjustment 2 ¼") Long Fits Evolution/Icon Backs 12" 88050 $75.00 Fits Evolution/Icon Back 14-15" 88010 $75.00 Fits Evolution/Icon Back 16-17" 88020 $75.00 Fits Evolution/Icon Back 18" 88030 $75.00 Fits Evolution/Icon Back 20-24" 88040 $75.00
Step 2 - Select Type of Pad (Sold as Each) Included in price of bracket. Replacements are $37.50 each. HCPCS: Included in HCPCS Code for bracket Item Number Size (in.) Contoured 04317 3X4 04319 4X5 04321 5X6 Linear 04307 04309 04311
3X4 4X5 5X6
Back System Accessories Supports HCPCS: None Item Number Description PSIS Block Lumbar Support-Small 04248 PSIS Block Lumbar Support-Medium 04249 PSIS Block Lumbar Support- Large 04259 Supplemental Lateral Support 04266
MSRP $40.00 $40.00 $40.00 $40.00
The Backrest™ HCPCS: None Item Number Description Charcoal 03997 Miscellaneous colors- please call Varies Accessory Cover with Strap 04062
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MSRP $35.00 $35.00 $20.00
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U.S. Suggested Retail Price List Effective January 01, 2014
Secondary Supports - Pelvic Positioning 2-Point Unpadded Hip Belts - Single Pull HCPCS: E0978 Wheelchair Accessory, Positioning Belt/Safety Belt/Pelvic Strap Item Number Description Buckle Material Aircraft latch 81022 MTM Push button 82022 MTM
Length (in.) 60" 60"
Width (in.) 2 2
MSRP $75.00 $75.00
Pad Size (in.) 9x2½ 10⅝x2½
Width (in.) 1½ 1½
MSRP $75.00 $80.00
4x1½ 6x1½ 4x1½ 6x1½ 9x2½ 10⅝x2½
1 1 1 1 1½ 1½
$70.00 $70.00 $50.00 $50.00 $55.00 $60.00
Pad Size (in.) 9x2½ 10⅝x2½ 4x1½ 6x1½ 4x1½ 6x1½
Width (in.) 1½ 1½ 1 1 1 1
MSRP $80.00 $85.00 $75.00 $75.00 $55.00 $55.00
Pad Size (in.) 9x2½ 10⅝x2½
Width (in.) 1½ 1½
MSRP $95.00 $95.00
4x1½ 6x1½ 9x2½ 10⅝x2½
1 1 1½ 1½
$90.00 $90.00 $80.00 $85.00
2-Point Padded Hip Belts - Front Pull HCPCS: E0978 Wheelchair Accessory, Positioning Belt/Safety Belt/Pelvic Strap Item Number Description Buckle Material Medium, push button, single pull 83212 MTM 83312 MTM Large, push button, single pull 83012 83112 85012 85112 84212 84312
Extra small, side squeeze, single pull Small, side squeeze, single pull Extra small, side squeeze, single pull Small, side squeeze, single pull Medium, side squeeze, dual pull Large, side squeeze, dual pull
MTM MTM Molded Molded Molded Molded
2-Point Padded Hip Belts - Reverse Pull (Rear Pull) HCPCS: E0978 Wheelchair Accessory, Positioning Belt/Safety Belt/Pelvic Strap Item Number Description Buckle Material Medium, push button 83216 MTM 83316 MTM Large, push button 83016 MTM Extra small, side squeeze 83116 MTM Small, side squeeze 85016 Molded Extra small, side squeeze 85116 Molded Small, side squeeze
4-Point Padded Hip Belts - Front Pull HCPCS: E0978 Wheelchair Accessory, Positioning Belt/Safety Belt/Pelvic Strap Item Number Description Buckle Material Medium, push button, single pull 83214 MTM 83314 MTM Large, push button, single pull Extra small, side squeeze, single pull 85014 MTM Small, side squeeze, single pull 85114 MTM Medium, side squeeze, dual pull 84214 Molded Large, side squeeze, dual pull 84314 Molded
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Secondary Supports - Chest and Ankle Contoured Chest Harness - Top Pull HCPCS: E0960 Wheelchair Accessory, Shoulder Harness/Straps or Chest Strap Item Number Description Pad Size (in.) Extra small, side squeeze, shoulder cam 87115 9x1½ Small, side squeeze, shoulder cam 87215 13¾x1¾ Medium, side squeeze, Medium, shoulder side cam squeeze, shoulder cam 16x1¾ 87315 Large, side squeeze, Large, shoulder side cam squeeze, shoulder cam 18x1¾ 87415
Width (in.) 3/4 1 1 1
MSRP $130.00 $130.00 $130.00 $130.00
2-Point Chest Belt - Center Pull HCPCS: E0960/E0978 Wheelchair Accessory (Shoulder Harness/Straps/Chest Strap or Positioning Belt/Safety Belt/Pelvic Strap) Item Number Description Width (in.) MSRP Large, hook and loop 88027 2 $40.00
Bottom Pull Harness Accessory HCPCS: None Item Number Description Fits 3/4" webbing 87116 Fits 1" webbing 87117
MSRP $12.50 $12.50
Band-It™ Ankle Support - Single Pull HCPCS: E0978 Wheelchair Accessory, Positioning Belt/Safety Belt/Pelvic Strap Item Number Description MSRP Extra small, side squeeze, 4-6" circumference 89003 $115.00 Small, side squeeze, 6-9" circumference 89000 $115.00 Medium, side squeeze, 9-11" circumference 89001 $115.00 Large, side squeeze, 11-13" circumference 89002 $115.00
Tri-End Hardware HCPCS: None Item Number Description Tri-End fitting, pair, 3/4" 80000 Tri-End fitting, pair, 1" 80100 Tri-End fitting, pair, 1½" 80200 Tri-End fitting, pair, 2" 80300 Dual Tab Tri-End fitting, set of four, 1" 80500
MSRP $20.00 $20.00 $20.00 $20.00 $20.00
Cam Lock Buckles HCPCS: None Item Number Description Cam lock buckle, pair, 1" 80001
MSRP $4.00
Frame Clamps HCPCS: None Item Number Description Frame Clamp, pair, 3/4" 80102 Frame Clamp, pair, 7/8" 80202 Frame Clamp, pair, 1" 80302
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MSRP $4.00 $4.00 $4.00
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U.S. Suggested Retail Price List Effective January 01, 2014
Terms and Conditions of Sale Terms Standard billing terms are Net 30 from invoice date on accounts approved for open credit. New Accounts Only All new accounts must be approved by the area sales rep. To establish credit, a completed credit application must be received. Please allow two business days for processing. If product is needed immediately, we welcome the use of Visa®, MasterCard®, American Express® or Discover® to expedite your order. Minimum Orders Seating Systems: $100.00 with a $10.00 handling fee for orders under $100.00 Belts and Harnesses: No minimum. Shipping All shipments are FOB, Seattle, WA unless otherwise indicated. Freight charges will be prepay and additional. Returns All returns are subject to a 15% restocking charge plus all applicable freight charges. Merchandise may not be returned without prior approval of Cascade Designs, Inc. Please call for a return authorization number. All claims for shortages or damages must be made within 30 days of receipt of shipment. Payments Cascade Designs, Inc. welcomes the use of Visa, MasterCard, American Express, Discover or EFT (Electronic Funds Transfer) as payment for invoices. Checks should be payable in US funds to Cascade Designs, Inc., PO Box 94547, Seattle, WA 98124-6847. Dealer agrees to pay each invoice in accordance with its terms. Past Due Accounts Cascade Designs, Inc. may impose a service charge of 1.5% per month or the highest amount allowable by law, whichever is less, on any unpaid balance. Cascade Designs, Inc. may place all delinquent accounts on prepay terms and exercises the right to hold all shipments for credit review at our discretion. These terms and conditions are effective January 01, 2014. VARILITE reserves the right to change the Terms and Conditions of Sale at any time.
A Division of Cascade Designs, Inc. 4000 1st Avenue South Seattle, WA 98134 Phone: (206) 505-9500 Toll Free Phone: (800) 827-4548 Fax: (206) 343-5795 Toll Free Fax: (800) 363-7739
Authorized EU Representative: Cascade Designs, Limited Dwyer Road Midleton Co. Cork Republic of Ireland + 353-214-632-399
Business hours: 7:00 am to 4:30 pm PST Visit us online: www.varilite.com Email us:
[email protected]
Toll Free Phone: (800) 827-4548 | Toll Free Fax: (800) 363-7739 | www.varilite.com
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A Division of Cascade Designs, Inc.
4000 1st Ave. S Seattle, WA 98134 Phone: (800) 827-4548 Fax: (206) 343-5795 www.varilite.com
Authorized EU Representative: Cascade Designs, Limited Dwyer Road, Midleton, Co. Cork Republic of Ireland
© 2014 Cascade Designs, Inc.
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